| Submitted by: | Gordon Irlam |
| Date: | 2012-09-30 |
| Purpose: | Quarterly expense report |
| Reference: | 2012-GRICF-03 |
| Date | Category* | Description | Amount |
|---|---|---|---|
| 2012-07-05 | Health | Group | $300.00 |
| 2012-07-05 | Health | Insurance | $472.00 |
| 2012-07-12 | Health | Prescriptions | $90.00 |
| 2012-07-17 | Health | Eye exam | $25.00 |
| 2012-07-18 | Health | Glasses | $415.20 |
| 2012-07-30 | Health | Dentist | $174.00 |
| 2012-08-05 | Health | Insurance | $472.00 |
| 2012-08-15 | Health | Group | $240.00 |
| 2012-08-21 | Health | MedicAlert | $99.00 |
| 2012-09-04 | Accounting | Annual meeting | $375.00 |
| 2012-09-05 | Health | Insurance | $472.00 |
| 2012-09-12 | Health | Group | $180.00 |
| 2012-09-30 | Health | Therapy (13 x $170) | $2210.00 |
| Total expenses | $5524.20 | ||
| Less advances | $0.00 | ||
| Reinbursement due | $5524.20 | ||
| * - Valid categories: | Grants, Travel, Pubs, Office, Health, Programs, Other |
| Travel includes conf./meetings, transport, car-$0.55/mile, lodging, M&IE |
Signature:
| Approved by: | Purobi Phillips |
| Signature: | |
| Date: |